{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T20:55:07Z","timestamp":1793307307004,"version":"4.5.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"9","license":[{"start":{"date-parts":[[2018,8,22]],"date-time":"2018-08-22T00:00:00Z","timestamp":1534896000000},"content-version":"vor","delay-in-days":57,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,9,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>Diabetes distress among patients from ethnic minorities is still poorly understood. We investigated the association between ethnicity and diabetes distress among ethnic minority groups of people with type 2 diabetes in the Netherlands, focusing on the possible effects of glycemic control, lifestyle factors, cardiovascular risk factors, and diabetes complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>Cross-sectional data from the Dutch Diabetes Pearl cohort included people with type 2 diabetes from primary, secondary, and tertiary diabetes care programs. We used the 20-item Problem Areas in Diabetes Survey (PAID) scale to assess diabetes distress; a score \u226540 is considered to represent high distress. Ethnicity was estimated on the basis of country of birth. Sociodemographic and lifestyle data were self-reported; cardiovascular and metabolic data were retrieved from medical charts. Logistic regression analysis determined the association between ethnicity and diabetes distress, with Caucasians as the reference group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Diabetes distress scores and ethnicity were available for 4,191 people with type 2 diabetes: 3,684 were Caucasian, 83 were Asian, 51 were Moroccan, 92 were African, 134 were Latin American, 46 were Turkish, and 101 were Hindustani-Surinamese. Overall, participants in minority groups had worse health outcomes than those of Caucasian descent, and diabetes distress was more prevalent (ranging from 9.6 to 31.7%, compared with 5.8% among Caucasians), even after adjusting for age, sex, education level, alcohol use, smoking, BMI, lipid profile, HbA1c, medication use, and the presence of diabetes complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Among people with type 2 diabetes in the Netherlands, ethnicity is independently associated with high diabetes distress. Further research is warranted to explain the higher prevalence of diabetes distress in minority groups and to develop effective interventions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc17-2181","type":"journal-article","created":{"date-parts":[[2018,6,26]],"date-time":"2018-06-26T13:55:13Z","timestamp":1530021313000},"page":"1854-1861","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":31,"title":["High Diabetes Distress Among Ethnic Minorities Is Not Explained by Metabolic, Cardiovascular, or Lifestyle Factors: Findings From the Dutch Diabetes Pearl Cohort"],"prefix":"10.2337","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3475-0219","authenticated-orcid":false,"given":"Behiye","family":"\u00d6zcan","sequence":"first","affiliation":[{"name":"Erasmus Medical Center, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femke","family":"Rutters","sequence":"additional","affiliation":[{"name":"VU University Medical Center, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J.","family":"Snoek","sequence":"additional","affiliation":[{"name":"VU University Medical Center, Amsterdam, the Netherlands"},{"name":"Academic Medical Center, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandy","family":"Roosendaal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8857-7389","authenticated-orcid":false,"given":"Eric J.","family":"Sijbrands","sequence":"additional","affiliation":[{"name":"Erasmus Medical Center, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra J.M.","family":"Elders","sequence":"additional","affiliation":[{"name":"VU University Medical Center, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits","family":"Holleman","sequence":"additional","affiliation":[{"name":"Academic Medical Center, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanno","family":"Pijl","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cees J.","family":"Tack","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evertine J.","family":"Abbink","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold W.","family":"de Valk","sequence":"additional","affiliation":[{"name":"University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce H.R.","family":"Wolffenbuttel","sequence":"additional","affiliation":[{"name":"University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coen D.A.","family":"Stehouwer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas C.","family":"Schaper","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the 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